慢性病毒性肝炎患者血清铁检测与肝脏生化与病理的关系

目的：探讨血清铁与慢性肝炎血生化指标及病理炎症分级（Ｇ）,纤维化分期（Ｓ）及分度（Ｓ）的相羞生及血清铁的检测意义。方法：对４５５例慢性肝炎患者血清铁检测,并与肝脏生化指标、肝炎炎症分级、纤维化分期和分度做直线相关分析,同时分析轻、中、重度慢性肝炎血清铁是否存在差异。结果：血清铁与ＡＬＴ、ＡＳＴ、ＢＩＬ呈正相关;而与ＣＨＥ呈负相关;与肝脏病理指标中的Ｇ、Ｓ、Ｄ均呈正相关。血清铁均值随慢性肝炎程度的加     

血清生化指标与慢性乙肝患者肝细胞炎症的相关性研究

目的探寻临床肝病常用血清生化指标与慢性乙肝患者肝细胞炎症的相关性,以期寻找无创伤性评价肝炎病变程度的方法。方法选择128例慢性乙肝患者,检测其丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、天门冬氨酸氨基转移酶（AST）、白蛋白（ALB）和凝血酶原活动度（PTA）,并将其结果与肝炎病理分级进行对比分析。结果 AST、ALT、PTA在不同病理分级（炎症）之间均有统计学差异（P均〈0.05）,且随着肝细胞炎症程度加重数值增大;ALB在不同病理分级（炎症）之间均有统计学差异（P〈0.01）,随着肝细胞炎症程度加重数值减小;ALP和GGT在不同病理分级之间无统计学差别。结论 ALT、AST、ALB、PTA能反映慢性乙肝肝细胞的炎症程度。     

784例慢性乙型肝炎患者血清生化和病理特征分析

慢性乙型肝炎是临床常见疾病，其发病机制特别是引起肝组织炎症活动和纤维化的机制错综复杂，而肝组织病变的同时可伴有血清生化指标的异常。本研究回顾性分析784例慢性乙型肝炎患者的肝组织病理特点以及肝组织小同病变程度间肝功能指标的差异，旨在进一步了解肝组织病变程度和血清生化水平的关系。     

慢性病毒性肝炎肝脏病理组织学改变与内毒素检测的关系

慢性病毒性肝炎患者血中所检测到的内毒素,大多认为是慢性病毒性肝病网状内皮系统功能降低或病理结构改变而致。本文通过对61例有肝组织学诊断的慢性病毒性肝炎患者同期进行内毒素水平的定量检测,对其病理分型、炎症活动度及纤维化程度与内毒素的关系进行了分析。 1 资料与方法 1.1 病例选择 61例慢性病毒性肝炎均为本院住院患者,年龄为14～52(35.6±11.7)岁。男性52例,女性9例。其中     

病毒性肝炎血清氨基酸谱与病理改变关系研究

通过对６４例经病理检查证实诊断的各型病毒性肝炎患者的血清氨基酸谱检测,结果表明慢性肝炎时血清氨基酸浓度出现明显变化,谷氨酸、蛋氨酸、酷到升主晚期胶氨酸、苯丙氨酸亦明显增加,支芳比随着病情加重是而降低,其变化程度与肝细胞炎症、坏死范围肝功能损害呈正相关。     

慢性病毒性肝炎临床分型与病理分型的对比分析

目的探讨慢性病毒性肝炎临床分型与病理分型的关系。方法按照“９５方案”就我院１９９３～１９９８年５月经肝穿活检病理确诊的５４６例慢性病毒性肝炎患者,将其临床分型与病理分型及分型诊断标准进行了对比分析。结果本组资料表明按“９５方案”慢性肝炎临床诊断与病理诊断总符合率为８２７８％,轻度、重度与病理符合率分别为９３５４％、９４４４％;中度慢性肝炎符合率仅４０％。慢性肝炎中度与重度ＳＢ、Ａ的比较无统计学意义（Ｐ均＞００５）,而ＰＴＡ的比较两组有显著性差异（Ｐ＜００１）,ＰＴＡ是判断慢性肝炎病轻重的敏感而可靠的指标。结论“９５方案”比较科学和客观的反映了慢性肝炎的临床诊断标准,但部分诊断标准有待进一步探讨。     

慢性乙型肝炎患者血清脂质水平与病理分级分期的关系

目的:探讨慢性乙型肝炎肝组织病变严重程度与血清脂质水平的关系．方法:采用全自动生化分析仪测定130例慢性乙型肝炎患者和30例正常人血清总胆固醇 (TC)、甘油三酯(TG)、高密度脂蛋白胆固醇 (HDL-C)、低密度脂蛋白胆固醇(LDI-C)、极低密度脂蛋白胆固醇(VLDL-C),并与慢性乙型肝炎患者肝组织病理分级分期进行对比分析．结果:慢性乙型肝炎患者血清的脂质水平随着肝组织炎症程度加重、肝组织纤维分期升高而逐渐降低,较重的肝组织炎症活动程度 (G3、G4)、较重的肝组织纤维分期(S4)与对照组比较,有显著差异(P<0．05或<0．01),较轻的肝组织炎症活动程度(G1、G2)、较轻的肝组织纤维分期(S0、S1、S2、S3)与对照组比较,差异不显著(P>0．05)．结论:测定血清脂质水平对判断较重的慢性肝炎肝组织实质细胞的损害和预后估计有一定的价值．     

慢性肝炎病理分类与临床的关系

目的 探讨慢性肝炎的临床资料与病理分级、分期的符合度。方法 复习我院１２３例慢性肝炎患者肝穿刺标本的病理分类与其临床资料之间的关系。结果 ＡＳＴ、γ－球蛋白、γ－谷氨酰转肽酶（γ－ＧＴ）与病毒复制水平４项指标的平均值在不同级别中呈正相关,且差异显著。结论 ＡＳＴ、γ－球蛋白、γ－ＧＴ与病毒复制水平４项指标能帮助我们评估患者的肝脏病理分级。     

慢性乙型肝炎患者血生化指标与肝组织病理的相关性

目的评价慢性乙型肝炎患者血生化指标诊断肝组织炎症活动度与纤维化程度的临床价值。方法对205例慢性乙型肝炎患者活体肝穿刺的病理标本进行组织炎症活动度分级(G)和纤维化程度分期(S),并分别与同期检测的血清肝功能指标比较。结果血清TBIL、ALT、AST、GGT平均值随病理分级和分期的增加而逐渐升高,ALB、PTA则相反;与病理诊断比较,临床诊断的灵敏度分别为:轻度83.5%(81例),中度56.8%(46例),重度51.9%(14例)。结论血清TBIL、ALT、AST、GGT可反映慢性乙型肝炎肝组织炎症活动的程度;ALB、PTA是慢性乙型肝炎病变进展的指标。     

血清生化指标对慢性肝炎病变程度的评价

目的:分析临床肝病常用血清生化指标与慢性肝炎病变程度的相关性.方法:检测慢性肝炎患者142例的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、白蛋白(ALB)、总胆红素(TBIL)和凝血酶原活动度(PTA),并将其结果与肝炎病变程度(病理分级和分期)对比分析.结果:ALT、AST、ALB和PTA在不同病理分级(炎症)之间均有显著性差异( F = 6.812,6.592,10.131,3.247,P<0.05或0.01); ALT、AST、ALP、GGT、ALB、TBIL和PTA在不同病理分期(纤维化)之间无显著性差异;TBIL、PTA和病理分级呈正相关,ALB和病理分级分期呈负相关.结论:常用血清生化指标ALT、AST、ALB、PTA能反映慢性肝炎的炎症程度,但不能反映慢性肝炎的纤维化程度.     

慢性乙型肝炎患者血清HBV DNA载量与肝组织病理学变化关系研究

探讨慢性乙型肝炎轻度患者血清HBV DNA载量与肝组织病理学变化的关系。方法根据血清HBeAg状态将310例慢性乙型肝炎轻度患者分为HBeAg阳性和HBeAg阴性,应用荧光定量PCR技术检测血清HBV DNA水平,常规进行肝活检术和病理学观察,分析血清HBV DNA载量与肝组织病理学变化的关系。结果224例HBeAg阳性患者肝组织炎症程度以G0（42.0%）为主,纤维化程度以S0（58.0%）为主;86例HBeAg阴性患者炎症程度以G0（29.1%）、G1（30.2%）、G2（34.9%）为主,纤维化程度以S0（51.2%）为主;HBeAg阳性患者血清HBV DNA水平与肝组织炎症程度无明显相关（r=-0.098,P＞0.05）,与纤维化分期间存在负相关关系（r=-0.309,P＜0.01）;HBeAg阴性患者血清HBV DNA水平与肝组织炎症程度存在正相关关系（r=0.306,P＜0.01）,与纤维化程度无明显相关（r=0.112,P＞0.05）。结论 HBeAg阳性与HBeAg阴性患者血清HBV DNA载量与肝组织病理学变化的关系存在显著差别,应区别分析其临床意义。     

慢性病毒性肝炎血清总胆汁酸与肝组织细胞成分变化的相关性研究

目的探讨血清总胆汁酸（TBA）与慢性病毒性肝炎肝组织细胞成分变化的关系。方法对134例慢性病毒性肝炎患者做肝穿刺活检及检测血清TBA,应用病理图像分析仪以点计数法测量肝组织400倍镜视野内的主要细胞成分,测量内容包括良好肝细胞、变性肝细胞、纤维组织、脂肪细胞、淋巴细胞,计算各种组分的均数及密度。根据TBA水平的不同,将病人分成两组,比较两组病人之间五种肝组织细胞成分的差异,并使用多元线性逐步回归分析TBA升高者与肝组织细胞成分数密度的相关性。结果 （1）TBA升高组较TBA正常组的肝组织中良好肝细胞显著减少,变性肝细胞、纤维组织、脂肪细胞、淋巴细胞显著增多,差异有统计学意义（P〈0.005）。（2）TBA与变性肝细胞、肝纤维化、淋巴细胞数密度成正相关,相关系数分别为0.433、0.367、0.494,与良好肝细胞、脂肪细胞无统计学相关。结论 TBA升高与淋巴细胞数密度的相关性最密切,TBA升高可能具有间接或直接反映慢性病毒性肝炎患者肝组织的细胞免疫状态。     

Influence of iron on the severity of hepatic fibrosis in patients with chronic hepatitis C

AIM: To evaluate the association among hepatic fibrosis, serum iron indices, and hepatic iron stores in patients with Chronic Hepatitis C (CMC). METHODS: Thirty-two CHC patients were included in our study. The histological degree of fibrosis and inflammation activity was assessed according to the Metavir system. The serum iron indices including ferritin, iron and transferrin saturation were measured. Hepatic iron deposition was graded by Perls' stain. RESULTS: The CHC patients with severe hepatic fibrosis (n = 16) were significantly older than CHC patients with mild fibrosis (n = 16) (P = 0.024). The serum iron indices, increased serum iron store and positive hepatic iron stain were not significantly different between the two groups. In multivariate logistic regression analysis, the age at biopsy was an independent predictor of severe hepatic fibrosis (Odds ratio = 1.312; P = 0.035). The positive hepatic iron stain was significantly associated with the values of alanine aminotransferase (ALT) (P = 0.017), ferritin (P = 0.008), serum iron (P - 0.019) and transferrin saturation (P = 0.003). The ferritin level showed significant correlation with the value of ALT (r = 0.531; P = 0.003), iron (r = 0.467; P = 0.011) and transferrin saturation (r = 0.556; P = 0.002). CONCLUSION: Our findings suggest that the severity of hepatitis C virus (HCV)-related liver injury is associated with patient age at biopsy. Both serum iron indices and hepatic iron deposition show correlation with serum indices of chronic liver disease but are not related to grade and stage of liver histology.     

慢性乙型肝炎肝脏病理与可溶性白细胞介素2受体关系探讨

目的探讨慢性乙型肝炎病理与血清中可溶性白细胞介素2受体(sIL-2R)在慢性乙型肝炎发病机制中的作用和临床应用的价值.方法采用双抗体夹心酶联免疫法检测了307例病人血清sIL-2R(其中275例慢性乙型肝炎和16例脂肪肝均做了肝活检,16例慢性重型肝炎未做肝活检),用自动生化分析仪检测了血清总胆红素(TB)、白蛋白(A)、球蛋白(G)、丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(γ-GT)等指标在肝脏病理各级炎症及各期纤维化中的改变.结果血清sIL-2R、TB、G、ALT、ALP和γ-GT均值随着肝脏病理炎症程度加重而逐渐增高,A均值则随着肝脏病理炎症程度加重逐渐下降,各组间比较有显著性差异P＜0.05或P＜0.01.sIL-2R、G均值随着肝纤维化的进展而逐渐增高,A均值则随着肝纤维化的进展而逐渐下降,各组间比较有显著性差异P＜0.05或P＜0.01.结论慢性乙型肝炎病人血清sIL-2R、TB、A、G、ALT、ALP和γ-GT水平的变化可作为判定肝组织炎症程度的参考指标,sIL-2R、A、G可作为判定肝纤维化程度的参考指标.     

慢性病毒性肝炎胆囊壁声像图厚度变化与肝组织病变类型的观察

目的了解慢性病毒性肝炎胆囊壁声像图变化与肝组织病变类型的关系。方法收集２９６例经病理检查确诊的慢性肝炎,将其胆囊壁声像图的改变与肝组织病变类型的变化规律进行对比分析。结果Ｂ超检测慢性肝炎胆囊壁总异常率为５６７６％,其中轻度（１０４／２１１）占４９２８％,中度（７０／７５）９３３３％,重度（１０／１０）１００％。慢性肝炎中度、重度与轻度组经χ２检验Ｐ＜００１、Ｐ＜００５,有显著性差异。胆囊壁厚度与肝脏病理变化的对比显示,胆囊壁厚度逐渐增加,肝脏病理损害也随之加重。轻度与中度组经ｔ检验Ｐ＜００１;轻度与重度组Ｐ＜００１;重度与中度组Ｐ＜００１。结论胆囊壁声像图厚度变化对慢性病毒性肝炎的临床分型、判断病情具有很重要的参考价值。     

FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis

Background  The aim of this study was to assess the diagnostic performances of liver stiffness measurement (LSM), ultrasonography (US) and their combined use in predicting the extent of hepatic fibrosis. Methods  Consecutive patients with chronic hepatitis B (HBV) or hepatitis C virus (HCV) infections, with indications for liver biopsy, were prospectively enrolled. LSM was performed on the same day as biopsy. US scores, including assessment of liver surface, liver parenchyma, intrahepatic vessels and spleen index, were used to assess the degree of hepatic fibrosis. The pathological findings were used as a reference standard and diagnostic accuracy was assessed and compared. Results  Three-hundred and twenty patients, including 199 men and 121 women, with a mean age of 50.8 years, were analyzed. There were 214 (66.9%) HCV patients, 88 (27.5%) HBV patients and 18 (5.6%) patients with both HCV and HBV. LSM correlated significantly with the hepatic fibrosis (F) scores, necro-inflammatory activity and US scores in multivariate analysis. The diagnostic accuracy of LSM is significantly superior to US, and equal to combined LSM with US, in the prediction of all HCV-related fibrosis scores. The cut-off value of LSM is 6 kPa for diagnosing F > =1, with a positive predictive value of 91%. Also, the cut-off value is 12 kPa for the prediction of cirrhosis, with a negative predictive value of 94%. Conclusions  LSM is useful for predicting hepatic fibrosis and excluding cirrhosis. A combination of LSM and US does not improve the accuracy in assessing hepatic fibrosis.     

病毒性肝炎患者血清新喋呤检测的临床意义

研究血清新喋呤水平与慢性病毒性肝炎、肝炎肝硬化、慢性重型肝炎和感染的关系和意义。采用ELISA法检测35例慢性乙型肝炎,26例肝炎肝硬化,35例慢性重型肝炎。其中合并感染患者共19例。研究显示慢性重型肝炎组血清新喋呤水平明显高于肝炎肝硬化组和慢性肝炎组;合并感染患者血清新喋呤高于非感染患者。新喋呤水平与TBil和TBA密切相关。病毒性肝炎患者血清新喋呤水平与肝病严重程度和感染有关,对病情判断和感染诊断有参考意义。     

Prevalence of HFE mutations and relation to serum iron status in patients with chronic hepatitis C and patients with nonalcoholic fatty liver disease in Taiwan

AIM: To assess the prevalence of the two mutations, C282Y and H63D of HFE gene, in healthy subjects, patients with chronic hepatitis C (CHC), and patients with nonalcoholic fatty liver disease (NAFLD) in Taiwan and to explore the contribution of the HFE mutation on serum iron stores in CHC and NAFLD groups. METHODS: We examined C282Y and H63D mutations of HFE gene in 125 healthy subjects, 29 patients with CHC, and 33 patients with NAFLD. The serum iron markers, including ferritin, iron, and total iron binding capacity (TIBC), were assessed in all patients. RESULTS: All of the healthy subjects and patients were free from C282Y mutation. The prevalence of H63D heter-ozygosity was 4/125 (3.20%) in healthy subjects, 2/29 (6.90%) in CHC group, and 1/33 (3.03%) in NAFLD group. The healthy subjects showed no significant difference in the prevalence of H63D mutation as compared with the CHC or NAFLD group. Increased serum iron store was found in 34.48% of CHC patients and 36.36% of NAFLD patients. In three patients of H63D heterozygosity, only one CHC patient had increased serum iron store. There was no significant difference in the prevalence of HFE mutations between patients with increased serum iron store and those without in CHC or NAFLD group. CONCLUSION: The HFE mutations may not contribute to iron accumulation in the CHC or NAFLD group even when serum iron overload is observed in more than one-third of these patients in Taiwan.     

乙型肝炎病毒基因型与病毒复制的关系

检测慢性乙型肝炎患者血清乙型肝炎病毒(HBV)基因型和病毒载量(HBV-DNA定量),探讨它们之间的关系。用微板核酸杂交-ELISA方法对HBV进行基因分型,用PCR荧光定量检测血清HBV-DNA水平,共318例。检测到HBV B型111例(35％);C型128(40％);混合型(B+C,C+D,B+C+D)45例(14％);D型2例;F型2例;未分型30例(9.4％);没有发现A、E型。结果发现,C型和混合型HBV的血清DNA水平高于B型(1.14×107vs2.2×107vsl.60×106拷贝/ml,P<0.05);而混合型HBV的血清DNA水平与C型无差别(P=0.127)。研究提示,我国HBV以B,C两基因型为主,HBV基因型可能是影响HBV复制的重要因素之一。